Protocol for the process evaluation of a cluster randomised trial of audit and feedback and in practice educational training to reduce antibiotic prescribing in dental primary care: the TiPTAP trial.

Background: Antibiotic resistance is one of the top global health threats and inappropriate use of antibiotics is one of the major contributors. The training in practice targeting antibiotic prescribing (TiPTAP) trial was developed to try to reduce antibiotic prescribing within primary care dentistry in Scotland through audit and feedback (A&F) and an additional educational training component. Participants were randomised to either the control group which received individual A&F only or to the intervention group which received individual A&F as well as the TiPTAP educational training component. The beginning of the trial coincided with the COVID-19 pandemic as well as other significant changes within dentistry in Scotland that could potentially have an effect on the delivery and outcomes of the trial. A process evaluation of the trial will be conducted in order to thoroughly examine the processes and contextual factors surrounding the trial.Methods: The process evaluation will be based on the Medical Research Council (MRC) guidance for conducting process evaluations of complex interventions and will be underpinned by the US National Institute of Health Behaviour Change Consortium’s (BCC) fidelity framework. A mixed methods approach will be used for data collection including a post training questionnaire, training session observations, and participant and trainer interviews. Qualitative and quantitative data will be triangulated to give an overall assessment of the TiPTAP trial.Discussion: The process evaluation will allow for an extensive assessment of the implementation of the trial as well as the impact of contextual factors that may influence the trials delivery and outcomes. This will allow for a better understanding of the trial results and will inform any future implementation of TiPTAP or similar audit and feedback interventions.